'At least there is something in my bra': A qualitative study of women's experiences with oncoplastic breast surgery

Abstract Aims This study explores how women diagnosed with breast cancer may be supported by physicians and nurses during physical and existential changes related to oncoplastic breast surgery in Denmark. The following research questions were addressed: (a) how do women experience oncoplastic breast surgery, and (b) how does cancer treatment affect their body image? Design A descriptive qualitative study design with a six‐step thematic analysis influenced by Braun and Clarke was applied in this study. This paper has been prepared in accordance with the consolidated criteria for reporting qualitative research. Methods Fourteen in‐depth interviews with seven women diagnosed with breast cancer were conducted from August 2018 to March 2019. In this qualitative study, data analysis was performed concurrent with data construction, recognizing that the process of analysis and making sense of data should start during the interviews. We explicitly frame the discussion of the findings in a theory of embodiment influenced by Merleau‐Ponty, consistent with the construct of exploring human experiences to generate meaningful knowledge for applied practice. Results Two overall themes with related subthemes were identified: (1) 'Treatment is required for life‐threatening cancer', and (2) 'Striving for a new normal body'. Across both themes, women's experiences reflected a 'time pendulum' as they contemplated their past identity, their current rationale and their transition to a future beyond breast cancer with a changed body. Conclusion Participants reflected on their past, present and future when facing an altered body image caused by their breast cancer diagnosis and oncoplastic breast surgery. The participants in the study expressed broad levels of satisfaction with the results of the oncoplastic breast surgery. The reconstructed breast helped them to live normally again, in particular maintaining interpersonal relationships. Breast reconstruction supported participants' embodiment experiences and redefinition of their 'new normal'. Impact This study showed the dynamic changes in self‐definition from receiving a breast cancer diagnosis and cancer treatment to oncoplastic breast surgery. The main finding of self‐redefinition was from the perspective of breast cancer women who were in a period of transition between post‐diagnosis and consultation for oncoplastic breast surgery. The findings indicate that advanced nurse specialists in the field of oncoplastic breast surgery can enhance psychosocial wellbeing and support women pre‐ and post‐operatively by focusing on patient experiences of self‐image and embodiment.


| INTRODUC TI ON
Women diagnosed with breast cancer in Western countries are increasingly offered oncoplastic breast surgery as part of breast cancer treatments. Formerly, the primary focus of breast cancer treatment was lumpectomy or mastectomy, with little to no focus on postsurgical aesthetics or psychosocial aspects related to the process and its result. However, the number of breast cancer survivors continues to grow due to advancements in surgical and medical treatment.
Therefore, long-term outcomes and the experiences of individuals with breast cancer, such as quality of life related to body image and satisfaction, have become increasingly important components of breast cancer treatment and rehabilitation. Moreover, the development of surgical techniques such as microsurgery offers more opportunities and solutions in oncoplastic breast surgery (Macmillan & McCulley, 2016). Contemporary, state-of-the-art aesthetic goals for oncoplastic breast surgery have therefore evolved to include the retention or restoration of one or both breasts to near normal shape, appearance, symmetry and size following breast cancer surgery.
Standards for oncoplastic breast surgery are now described in a European guide on best practices (Gilmour et al., 2021). In Denmark, the Danish Breast Cancer Cooperative Group and the Danish Health Authority provide guidelines on best practices for breast cancer for accelerated inquiry, diagnostics and treatment, including oncoplastic breast surgery, if relevant (The Ministry of Health, 2018).
Previous research indicates that women who undergo breast reconstruction after breast cancer treatment report the highest long-term satisfaction with their breasts, with a lower incidence of depression, while women undergoing mastectomy without reconstruction report the lowest satisfaction (Atisha et al., 2015). This could indicate that reconstruction should be recommended for all women diagnosed with breast cancer. However, although nurses advocate for scientific evidence about care, health and illness, they also know that the standardizing tendencies of evidence-based practice can overrule individual variation, cultural needs, preferences and rights. In nursing theory, bodily changes are not simply objective goals, they are also subjective experiences that influence the individual's experience of the body in the world and the lived life. Furthermore, individuals are challenged and confronted with the fact that bodies are individually experienced but culturally and socially produced (Hopwood & Hopwood, 2019a), meaning that women's bodily experiences might be too complex and individual a phenomenon to capture through simple satisfaction outcomes.
During clinical practice, nurses meet women recently diagnosed with breast cancer who struggle with complex decisions about whether to choose oncoplastic breast surgery or conventional breast cancer surgery. Women are usually offered one of three equally effective oncologic surgical strategies: breast-conservation surgery, mastectomy or mastectomy with breast reconstruction (and contralateral symmetry surgery, when relevant). The care and treatment of women undergoing these surgeries require nurses to consider issues related to body image and other psychosocial aspects. This qualitative study investigated experiences of Danish women diagnosed with breast cancer who received oncoplastic breast surgery to learn how nurses can support women during such bodily and existential changes.

| Background
The prognosis for breast cancer has significantly improved in recent decades: currently, over 1 million women worldwide are diagnosed with breast cancer annually, and there is a 75% survival rate in most developed countries (World Health Organization, 2021). As a result, cosmetic concerns after breast cancer treatment affect an increasing number of women, including scars, large excision volumes, breast asymmetry, breast shape change, nipple displacement, scar retraction, skin alterations and radiation boost that can negatively impact outcomes in addition to the issues previously listed (Everaars et al., 2021;Ozmen et al., 2015). Further, poor cosmetic results may negatively impact body image and self-esteem, or result in impaired sexuality or depression (Negenborn et al., 2017). Emphasizing cosmetic results may decrease psychological distress and improve the quality of life in breast cancer survivors (Hau et al., 2013;Kim et al., 2015).
Women diagnosed with breast cancer face different options for treatment, including surgery, chemotherapy, irradiation and hormonal therapy. In Denmark, multidisciplinary tumour management conferences provide recommendations for treatment at regular meetings comprising a team of healthcare specialists, including pathologists, oncologists, breast surgeons, plastic surgeons and registered breast cancer care nurse coordinators, all of whom are main finding of self-redefinition was from the perspective of breast cancer women who were in a period of transition between post-diagnosis and consultation for oncoplastic breast surgery. The findings indicate that advanced nurse specialists in the field of oncoplastic breast surgery can enhance psychosocial wellbeing and support women pre-and post-operatively by focusing on patient experiences of self-image and embodiment.

K E Y W O R D S
advanced nursing, breast cancer, longitudinal research, oncoplastic breast surgery, recovery, supportive care needs involved at different stages of a patient's cancer management plan.
Based on a review of individual patients, this team reaches a consensus on suggested treatment. Treatment recommendations are based on tumour pathology, cancer stage, indications of potential metastasis and patient status, to achieve positive oncological outcomes and acceptable aesthetic results (Gilmour et al., 2021;Prades et al., 2015), and may include oncoplastic breast surgery and contralateral symmetry surgery. Oncoplastic breast surgery is a fairly new technique that combines plastic surgery with surgical oncology.
In a typical procedure, the tumour is removed and the remaining breast tissue is reshaped or expanders are implanted to achieve symmetry and a more natural breast appearance (Berry et al., 2010).
Oncoplastic breast surgery reduces (a) the time required to adjust to a reconstructed breast and altered body image (typically, this takes 1 year or more), including potential impacts on quality of life, emotional well-being and intimacy; and (b) the range of physical and psychological impacts of surgery (e.g., discomfort, lack of sensation, self-consciousness, body image issues) that may contribute to dissatisfaction with outcome (Gilmour et al., 2021). Body image is a key motivation for oncoplastic breast surgery. However, the procedure is more complex than standard breast cancer surgery and requires either both a breast surgeon and a plastic surgeon to carry out the operation, or one surgeon with oncoplastic certification, which may delay the patient's cancer management plan. Significant delays to breast cancer surgery may be associated with an increased risk of mortality (Hanna et al., 2020). Furthermore, oncoplastic breast surgery often requires volume displacement or volume replacement techniques, with contralateral symmetry surgery as required (Rizki et al., 2013).
The term body image relates to the concept of body and mind and has been developed and characterized by different historical and epistemological approaches. Modern dualistic approaches can be traced back to René Descartes (1596-1650), who saw human beings as consisting of two parts, body and mind, implying a mechanical perception with no causal connection between the two parts (Cash & Pruzinsky, 2002). In contrast, in 1944, the phenomenologist Maurice Merleau-Ponty described the concept of the mind and body as a whole (Merleau-Ponty, 2011). In 1990, Bob Price, a nurse, developed the body image care model (Price, 1990), which focuses on how humans experience bodily changes as a result of illness, injury or disability. The model describes body image as influenced by three dimensions: body ideal, body reality and body appearance.
From an anthropological perspective, the body is viewed as a product of a specific historical, social and cultural context that influences how a person interacts with the surrounding world. The literature increasingly recognizes that the interface between the physical, psychological and social realms matters for body image. Patients may be affected by medical illness and treatment, leading to an altered body, changes in bodily functions and the personal and social consequences of these changes (Hopwood & Hopwood, 2019b;Rezaei et al., 2016).
The results from previous research on body image following treatment for breast cancer are diverse. Most studies concentrate on women's experiences related to body image after either mastectomy or lumpectomy (Brunet et al., 2013;Collins et al., 2011). These studies find that overall, women experience physical changes in a mostly negative way, which shapes their perceptions, thoughts, attitudes, feelings and beliefs about their bodies. Other research finds that discomfort related to body image decreases over time regardless of the type of breast surgery, if comparing breast-conserving surgery, mastectomy alone and mastectomy with reconstruction (Collins et al., 2011). Furthermore, research also shows that mastectomy is associated with more body image issues compared with lumpectomy and mastectomy with reconstruction, and that women who have had reconstruction experience higher satisfaction with their sexual life and with the aesthetic and cosmetic result (Marinkovic et al., 2021).
In addition, these women tend to experience less embarrassment related to their body and less negative attention related to the disease (Fernández-Delgado et al., 2008). Women who choose reconstruction also tend to experience a balanced body image and expect to retain a sense of femininity, both physically and mentally (Collins et al., 2011;Crompvoets, 2006;Snöbohm et al., 2010). Other research indicates that women's experiences of body image can be subjective and dependent on multiple individual factors, such as context, culture, social relations, cancer severity, tumour size, stage and volume of excision, among others (Gilmour et al., 2021;Negenborn et al., 2017). In summary, a growing body of literature evidences that the experience of breast cancer seriously affects women and their overall sense of body image (Boquiren et al., 2013;Jabłoński et al., 2019) for years after diagnosis and treatments (Dahl et al., 2010).
In the care and treatment of women diagnosed with breast cancer, hospital nurses and physicians still tend to evidence a dualistic understanding of the body, focusing more on treatment regimens and less on the whole person (Paraskeva et al., 2019;Schmid-Büchi et al., 2008). The complexity of body image presents an ongoing challenge to better recognize and understand the diverse issues underpinning it, including the extent and causes of, and recovery from, body image disruption (Hopwood & Hopwood, 2019b). The available research and knowledge on body image after oncoplastic breast surgery is sparse, as most research has investigated body image using scale-based questionnaires rather than individual self-expression.
Furthermore, little is known about the information needed by women receiving oncoplastic breast surgery, or their expectations.

| Research questions and aims
This study aimed to investigate how women diagnosed with breast cancer may be supported by nurses during bodily and existential changes related to oncoplastic breast surgery. The following research questions were addressed: (a) how do women experience oncoplastic breast surgery over time, and (b) how does cancer treatment affect their body image over time?

| Design
The design of this study was influenced by the authors' and their nursing colleagues' experiences in a breast surgery outpatient clinic.
Nurses reported that physicians advocated for oncoplastic surgery to provide improved aesthetic results after breast cancer and thereby achieve an improved quality of life in the long term, as showed in research (Atisha et al., 2015). However, nurses noted that patients' levels of satisfaction related to their breast(s) were more associated with body image, acceptance of the oncoplastic surgery, and postoperative pathways. Therefore, the authors assumed that women's perspectives on experiences of body image over time, both during and after oncoplastic cancer treatment, could provide insights to inform future practice. To explore this, a descriptive qualitative study design with a thematic analysis influenced by Braun and Clarke was chosen for its capacity to explore women's experiences (Braun et al., 2013), and individual in-depth interviews with key informants were collected. Individual interviews are ideally suited to explore experiential research questions and can also be useful for exploring understandings and perceptions (Braun & Clarke , 2013). The study was conducted by two experienced female nurse researchers employed at the same department. The first author is a registered nurse, Master of Science in Nursing and PhD, while the second author is a nurse specializing in clinical practice with more than 10 years of experience in applied research. An EQUATOR checklist for reports of interviews and a COREQ focus group studies checklist were applied (Tong et al., 2007); see further details in Appendix B.

| Participants and settings
Participants were recruited face to face by the second author in August and September 2018 at a large breast surgery outpatient clinic at a Danish university hospital, during patient consultation appointments. At the time of the interviews, the department of plastic surgery and the department of breast surgery were separate departments located at different hospitals in the region. This was a limitation for the speciality, complicating interprofessional collaboration between the departments involved in the treatment and care of women diagnosed with breast cancer. In 2015, the departments were merged into the Department of Plastic and Breast Surgery but were not physically consolidated at the same hospital location until 2020.
In total, nine candidates for oncoplastic breast surgery were invited to participate in the interviews. Two women declined to participate. The participants were therefore seven female Danishspeaking patients diagnosed with breast cancer or ductal carcinoma in situ who had chosen oncoplastic breast surgery. All participants had proactively requested oncoplastic breast surgery, which was not a standardized treatment at the time of the study due to limited collaboration between the specialities. Participants were purposefully sampled for maximum variation of demographic characteristics, providing variability of participant experiences with respect to the phenomenon explored. Participant demographics and other variables are presented in Table 1.
In Denmark, all facilities treating breast cancer are part of the multidisciplinary Danish Breast Cancer Cooperative Group, which prepares evidence-based guidelines about diagnostic procedures, treatment and follow-up to improve prognosis (The Danish Breast Cancer Cooperative Group [DBCG], n.d.). The healthcare system is government-funded for all citizens, indicating that the population served by any given treatment centre represents all patients regardless of socioeconomic background.

| Data collection
The interviews were conducted by the second author from August 2018 to March 2019 as in-depth interviews following a semi-structured interview guide (Braun & Clarke, 2013) influenced by Price's theoretical constructs of body ideal, body reality and body presentation, on the assumption that an altered body image affects women's experiences (Price, 1990). The interview guide is presented in Appendix A.
Participants met individually with the second author in a conference room in the hospital and were explained the research purpose and

| Data analysis and rigour
For rigorous qualitative sampling and saturation of data, Braun et al. (2013) propose that qualitative researchers require a sample that is appropriate to the research question and the theoretical aims of the study, and which can provide an adequate amount of data to fully answer the question and analyse the issue. After the 14 interviews, the authors concluded that the interview guide questions were rigorous enough for a substantial thematic analysis and sufficient to lead to relevant findings.
Interviews and analysis were initially guided by the research questions. However, as the process of data collection and interpretation evolved, the theoretical framework was adapted. The theoretical framework for the present study was influenced by Merleau-Ponty's phenomenology of perception and embodiment, consistent with the construct of exploring human experiences and producing meaningful knowledge for applied practice. Merleau-Ponty argues that human understanding comes from our bodily experience of the world that we perceive (Merleau-Ponty, 2011). He proceeds from the assumption that human existence is bodily and that we as subjects are embodied, meaning inseparable from our bodies and our world. He defines body image as 'the ways meanings, expectations, and habits are experienced and expressed in the body' (Merleau-Ponty, 2011). Thus, illness affects the whole person and its result is not simply objective, e.g., a reconstructed breast.
Rather, there is a complex relationship between meaning, body, and diagnosis and women diagnosed with breast cancer have their own perceptions of the illness. This approach enabled us to understand illness experiences from a first-person perspective.
Analysis was conducted using the six-step approach (illustrated in Figure 1) prescribed by Braun and Clarke (Braun & Clarke, 2006).
Thematic analysis is an accessible and flexible theoretical method of qualitative analysis to construct and organize data into themes across a dataset. The analysis was conducted as an abductive analytic process, moving back and forth from data to theorizing, to unfold and create narratives about the phenomenon investigated (Braun & Clarke, 2006).
Analysis was conducted on the transcribed textual data. The data from the first and second interviews for each patient were combined into one analysis to explore the individual patients' personal development and experience over time. First, the authors briefly read and discussed the transcripts of the interviews, focusing on participants' experiences related to the constructs of body ideal, body reality, body presentation and preliminary interpretations.
Then the first author conducted the process of coding in NVivo: first, an open coding, followed by an axial coding, looking across data to flesh out key conceptual dimensions and account for variations, leading to the construction of draft themes. NVivo supported this process by making procedures explicit and transparent. Next, the draft was discussed and interpreted by the first and second authors, leading to a novel construction and specification of themes.
The analysis was undertaken in Danish, and when final themes were identified, quotes selected to illustrate the themes and subthemes were translated into English. The selected quotes were translated forward and backward by the first author according to quality assurance criteria for accuracy and correct usage of language in medical translation (Karwacka, 2014). Translations were agreed on by the authors. Participant quotes are included in the following presentation of findings to support the analysis.

| Ethical considerations
Having received full information about the study aims and the data collection process, all participants provided informed written con-

| FINDING S
The analysis resulted in two overall themes, described in detail below: (1) 'Treatment is required for life-threatening cancer', and (2) 'Striving for a new normal body'. Common to the two themes were patients' feelings of being on a pendulum, reflecting on who they were in the past, their current rationale and transitioning to their life beyond breast cancer with a changed body. Figure 1 shows the conceptual time perspective that was an underlying mechanism throughout the identified themes.

| Theme 1: Treatment is required for lifethreatening cancer
This theme encapsulates the finding that participants were confronted with life-threatening cancer that required immediate treatment, and they were highly dependent on physicians for their treatment, and by extension, for their own future. The theme was further divided into two subthemes: 'The priority is to treat the cancer' and 'Being in the hands of the physicians'. Participants were dependent on the judgement of physicians, who acted as gatekeepers for treatment and surgical possibilities. Participants also compared the surgical outcome with the alternative of having no breast(s) and reasoned that the volume of the reconstructed breast(s) was better than a flat chest due to mastectomy.

| Wishing for a plan for my new breasts
During the second interview, the participants had completed the initial phases of treatment and were increasingly preoccupied with

| DISCUSS ION
This study was performed to investigate women's experiences with oncoplastic breast surgery and how the cancer treatment affected their experiences of body image. Two themes were identified: (1) 'Treatment is required for life-threatening cancer', and (2) 'Striving for a new normal body'. The first theme summarizes how participants focused primarily on treating the cancer; at the same time, they were dependent on physicians for their cancer treatment and surgical plans. The second theme expresses participants' reflections on future aspects related to their body and self, including their postsurgical experiences of breast reconstruction; this theme also reflects the fact that participants actively requested a plan and were striving to redefine themselves.
The themes and subthemes extracted from the interviews with participants illustrate the complex situation women confront when diagnosed with breast cancer, a potentially life-threatening disease.
The interviews indicate that 6 months after diagnosis, participants remained in a condition of acute crisis related to their cancer diagnoses, a finding confirmed by previous research (Berterö & Chamberlain Wilmoth, 2007). Even while managing this state of crisis, participants were striving for a future, one that incorporated their new breasts. This existential situation can be compared with the movement of a pendulum, a metaphor from psychology used with regard to coping strategies in the presence of death (Sand et al., 2009). The pendulum moves between dichotomous dimensions and elicits diverse reactions depending on personal and environmental factors, a metaphor that fits our findings. Participants discussed their past, including how their breasts were before their diagnosis. They expressed the situation as a rationale underlying their life events when expressing their perspectives on the oncoplastic breast surgery.
Participants also expressed uncertainty about their future related to the plan for oncoplastic surgery. This pendulum of past, present and future is illustrated in Figure 2. The pendulum effect was also seen in the transitioning, distress and repercussions for participants as they strived to identify with their altered body and self.
In Merleau-Ponty's phenomenology of perception, changing or replacing parts of the physical body leads to embodiment alterations  (Thomas, 2005).
Participants in our study experienced that adapting to embodied alterations could be hindered by uncertainty related to future surgical plans and results. Embodiment issues also manifested in how the participants related their self-image and bodily awareness to embodied normalization; striving to redefine the self was linked to the process of breast reconstruction, having 'something to put in the bra'.
This perspective of women's embodiment is supported by the embodied body framework by Hopwood and Hopwood, who introduced this framework as an aspect of psycho-oncology. The authors suggest a multidimensional approach to better recognize and understand the extent, causes and recovery related to altered embodiment; they state that humans cannot untether themselves from the past and that the past will always intrude on the present (Hopwood & Hopwood, 2019b).
Our findings support existing knowledge, affirming that coping with breast reconstruction surgery is complex, with multiple influencing factors. Furthermore, our study demonstrates the embodiment phenomenon among women who are interested in receiving breast cancer reconstruction surgery. The impact of breast reconstruction on participants' embodiment was to support them in redefining their 'new normal'. An interview study by Gershfeld and their ability to cope (Carr et al., 2019). The authors concluded that as nurses play a pivotal role in providing information to women recovering from breast reconstruction, improving communication channels between nurses and patients is likely to improve patients' experiences of support. Another study showed that nurses can assess women's specific support needs and partner with families to help them understand how best to support women during recovery (Carr et al., 2019), while other studies suggest psychosocial interventions to reduce body image-related distress in women with breast cancer (Brunet et al., 2021;Sebri et al., 2021;Sherman et al., 2018).
Our findings, together with the existing research on women's experiences with oncoplastic reconstruction, indicate doubts concerning the early benefits of reconstruction in general and oncoplastic breast surgery in particular. In some of the literature, oncoplastic breast surgery is presented to women as a procedure that 'cancels out' the mastectomy and facilitates a return to normalcy (Berry et al., 2010;Gilmour et al., 2021;Liu et al., 2018;Macmillan & McCulley, 2016;Riis, 2020;Weber et al., 2020), but this tends to underestimate the range of repercussions reported by women who have undergone the procedure.
Our findings show that women's experiences of oncoplastic breast surgery are complex on the individual level and that the repercussions of the surgery indicate the need for individualized and continuous support from nurses and physicians to support women throughout oncoplastic breast surgery and recovery. Some existing recommendations include increasing interprofessional collaboration at hospitals (Campbell-Enns et al., 2017;Retrouvey et al., 2020) or deploying advanced nurse specialists in the field of oncoplastic breast surgery specifically to enhance the focus on psychosocial aspects and support women pre-and post-operatively (Spector et al., 2010;Wilson et al., 2013 (Brown et al., 2021). This evidence clearly suggests that nurse specialists in the field of oncoplastic surgery have an essential role in supporting breast cancer survivors.
The contribution of the present study is that women experience a variety of emotions, sometimes moving from distress to hope for the future, during the process of oncoplastic breast surgery and transitioning to an altered body image. One implication for future practice is that nurses and physicians should carefully inform women about oncoplastic breast surgery, including providing information about the strict guidelines for candidates for oncoplastic breast surgery (Gilmour et al., 2021) and how the treatment is delivered by healthcare professionals from different departments. If women choose oncoplastic breast surgery, nurses and physicians can engage with the women's lived experiences of embodiment and recognize the importance of these experiences concerning the personal recovery process, for instance, through narratives in nursing (Damsgaard et al., 2021).

| S TRENG TH S AND LIMITATI ON S
To our knowledge, this is the first study to qualitatively investigate the experiences of women undergoing oncoplastic breast surgery influenced by a longitudinal perspective, defined as 'a study design in which data are collected at more than one point in time' (Polit & Beck, 2018). Additional research on embodied perspectives may help to improve nurses' and physicians' understanding of how individuals manage problems or phenomena in illness, leading to better ways of supporting women in oncology settings (Thomas, 2005). Qualitative research of this kind on the oncoplastic breast surgery population can provide additional evidence for developing supportive practices. The current study did not focus on the fact that oncoplastic breast surgery often involves benign contralateral symmetry surgery, which is complex itself and the implications of which should be discussed with patients (Rizki et al., 2013).
The small sample of seven participants providing 14 interviews may be considered a weakness of the study; however, the sampling rationale aimed to engage a small number of individuals experientially familiar with the phenomenon and willing to share their experiences (Braun & Clarke, 2013). The sample size was appropriate to explore the specific research questions on human experiences in oncoplastic breast surgery treatment and the underlying subjective, experiential nature of related phenomena (Braun & Clarke, 2013).
In terms of the quality criteria of validity and generalizability (Braun & Clarke, 2013), the findings in this study are dependent on the specific hospital department from which the participants were recruited, which influences external validity. However, the findings are highly relatable to existing research, which strengthens the trustworthiness of the results (Braun & Clarke, 2013). The findings provide nuanced perspectives from individuals undergoing oncoplastic breast surgery; however, the findings could have been more comprehensive if the study had proceeded as a multi-centre study. The study findings might also differ if the study was conducted today, as the department has since developed more advanced trajectories for breast cancer treatment, consolidating the departments of plastic and breast surgery.

| CON CLUS ION
The contribution of this study is the finding that participants' rationales related to their past, present and future can be compared with a pendulum, transitioning to an altered body image due to the diagnosis of breast cancer and the subsequent oncoplastic breast surgery. At the time of diagnosis, the participating women concentrated on treating cancer, confident in the treatment prescribed by their physicians, and they expressed little interest in the long-term oncoplastic breast surgery plan. As participants proceeded through treatment and towards surgery, they requested more information about the oncoplastic breast surgery procedures to clarify their future embodied self-image; they also suggested that this information could have been provided at the time of diagnosis, a suggestion that was at odds with the finding that treatment, rather than reconstruction, was the initial focus.
An implication for future practice is that nurses and physicians caring for women with breast cancer who are candidates for oncoplastic breast surgery need to provide person-centred care and information throughout the treatment process, from diagnosis and surgery to medical treatment and recovery, to engage with the women's lived experiences of embodiment and body image and to recognize the importance of these experiences in their transitions.

ACK N OWLED G EM ENTS
The study team would like to acknowledge the contribution of the patients who are participating in this study.

FU N D I N G I N FO R M ATI O N
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

CO N FLI C T O F I NTE R E S T
The authors declare that there is no conflict of interest.

Ethical clearance was obtained by the National Committee on
Health Research Ethics and the Danish Data Protection Agency (REG-104-2021).

PE E R R E V I E W
The peer review history for this article is available at https://publo ns.com/publo n/10.1111/jan.15309.

DATA AVA I L A B I L I T Y S TAT E M E N T
Data available on request due to privacy/ethical restrictions.

Interview questions
The patient's body reality Attention to: Satisfaction with size and shape of breasts, appearance, pain, physical condition, problems with physical activity, sexuality The surgeon's ability to inform. Confidence in the situation